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PERMITTEE NAME/ADDRESS (TnrAJr F.rNgNwWTa,nm dDrOww6 <br />NAME .~^ :.~ :. i.. ~.t ,.l ;tJ <br />ADDRESS .~n ? ~ r; <br />r. r. ~r !.' tj <br />FACILETV <br />LOCATION •..., ~ _ ' . <br /> <br />NATIONAL POLLUTANT OISCHMGE ELIMINATON SYSTEM lNPOESI <br />DISCHARGE MONITORING REPORT IOMR) <br />l1-161 I7-19/ <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM I ' L TO 1 _ ~' <br />1161/1 l11-131 I1i15/ 116-17/ r18-191 136311 <br />Form Approved. <br />p) ti D E / ~" ;i i 7 °'1 ~; p ONlB1Mo, 2040-0004.. <br />S I :, ~ . 1 Approval axpirPs 05-31-98 <br />I. I ,C_ I <br />NOTE: Reed Instructlora before oomplstin0 this form. <br />PARAMETER I3 Grd On/y/ QUANTfTY OR LOADING /4 Grd Onlyl QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE <br /> I4fr531 154-e11 !38-451 !46531 /54511 OF <br />l31-37I EX <br />MALrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161-s.T! (64681 169-701 <br /> SAMPLE .... .. 1 <br /> MEASUREMENT <br /> PERMIT <br />.. <br />..... <br />... - .. <br />. , , : .- .. `' <br />:. I .-. . , .. - r '; '~ .'. ~ REQUIREMENT ,: .y ~:. x ~ r <br />. ;: , ,. !. SAMPLE . .. - <br />... :. ~ . ( I.~ <br /> MEASUREMENT <br />. ) PERMIT ::'k .~; ::F .,;?;k ..r. ,'. ..:'t .. :. `a ! <br />. ~ ,') ~ 4 .l i ; .: REQUIREMENT r` p j ~ Y :r g :. / [. <br />~ ... r' a ~ ~. SAMPLE <br />. .... <br />.. <br />.. .. ( "1 ~ <br /> MEASUREMENT <br />~ PERMIT .. r ~ . ,. ~ .... .. ' I <br />... ~. %' ") i REQUIREMENT .. .. , , ..Y ; .F ~ . <br />r _ ~ .1 .) , . SAMPLE (` ± I ... . <br />_- ~ MEASUREMENT <br />~ 1 ,. PERMIT .... I. !. r . ~ . ~ ! - . <br />. , r ll :~'~ 1' . a `.. ~ ~ REQUIREMENT { ' . o ~ ~ ~ r <br />.. <br />. A 'i ~ ~ ~ SAMPLE ... r r r .. .. <br />„ ~ MEASUREMENT <br /> PERMIT . ~. %.i - _ ... .. .- ! <br />J „ - I ~ ~ REQUIREMENT ' 4 .. - ~ . -~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD TELEPHONE DATE <br /> AM FAMILIM WITH THE INFO RMATION SUBMITTED HEREIN; MD BASED ON <br />SChar:; <br />A <br />M11I1 <br />° <br />OTI MY INOUIIIY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />E THE BUSMITTED INFORMAT <br />ON IS ~ <br />F <br />E /' I i i <br />/ / <br />t <br />. <br />, <br />r OBTNNING THE IN <br />ORMATION, I BELI <br />V <br />I - <br />~ <br />' ice ;'rer ident TRUE. ACCUMTE MD COMRETE. I AM AWME THAT THERE ME <br />INCLUDING <br />SIONIFICMT PENAlTlES FOR SUBMITTING FALSE INFORMATION - . _~ -., ~ ~ ~.. ~~ ~ L , r <br />'" ' L ~ <br /> , <br />1 <br />1 Q7~ r/2 "~-/F7?1 ~~ Zn ~1 <br /> 00 <br />MD 37 <br />THE P059BILITY OF FNE MD IMPRISONMENT. SEE 16 U.S.C. f r BIONATUgE OF HIINCIPAL XECUTNE <br /> U.S.C. E 1710. IM,IW, utlr N,r mrun, m.y IncNA, rnr, y ro S 10,000 AREA <br /> <br />TYPED OR PRINTED <br />,n4 or ms„m,n hwrarlnwnrwan.Mnsmmet,.nss Frnl <br />OFFICEq Oq AUlHORRED AGENT <br />COpE NUMBER <br />YEAR <br />MO <br />DAY <br />1~OMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference ell ettsehmsnts here/ <br />EPA Form 3320-7 106-%) Previous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) I / PAGE OF <br />